HEALTH QUESTIONNAIRE - Associated General Contractors of Alaska (AGC)

HEALTH QUESTIONNAIRE

If you answer YES to any of the below questions you are not eligible to attend the class.

Fields marked with an * are required.

First Name *

Last Name *

Class Date *

Phone Number *

Email *

Confirm Class *

In the past 14 days have you:

Had an onset of cough, shortness of breath, chills, headache or fever of 100.3 or higher? *

Been tested for COVID-19 and are awaiting results, diagnosed with COVID-19, or contacted by a State *

Experienced shortness of breath at rest or not related to exertion, inability to lie down because of *

Experienced any abnormal or unusual conditions (not associated with allergies, smokers cough, other *

Provided care or have close contact with a person with COVID-19 (probable or confirmed) while they w *

Have you travelled outside of Alaska within the last two weeks? *

Have you had to quarantine within the last two weeks? *

If you have checked NO but you notice a change in your health within the next 14 days, we ask you to contact your class sponsor at 907-561-5354 or Training@agcak.org

Be prepared to follow the following safety protocols while attending this class: *

Provide your own writing utensil
Provide/obtain your own food and beverages (storage will not be provided)
Use provided hand sanitizer when entering/exiting
Wipe down your table and chairs at end of class with provided disinfectant

Safety Reminders:

Do not share office or protective equipment
Use sanitizer before touching community items
Wash hands frequently for at least 20 seconds with soap and water
Cover nose and mouth when coughing or sneezing with arm or tissue, dispose of tissue after use and wash hands after coughing or sneezing
Avoid touching face (mouth, eyes, nose)

What to expect:

Cleaning and sanitizing supplies will be provided
Class sizes will be within health mandated requirements
Two tables will be set 6ft apart from the rest of the class (Inform AGC staff if you plan to use these tables)

By checking this box, you confirm you answered truthfully, read thoroughly, and agree to abide by these expectations. *

I am responsibly preventing the spread of COVID-19

Please verify that you have checked the “I'm not a robot” checkbox.